High Cholesterol: Cholesterol-Lowering Medication

Sometimes cholesterol  medication is needed in addition to a low-fat, high-fiber diet to lower cholesterol.

Cholesterol helps your body build new cells, insulate nerves, and produce hormones. The liver makes all the cholesterol the body needs. But cholesterol also enters your body from dietary sources, such as animal-based foods like milk, eggs, and meat. Too much cholesterol in your blood can lead to coronary artery disease.

The first line of treatment for high cholesterol is usually to eat a low-fat, high-fiber diet and increase exercise. But, for some, these changes alone are not enough to lower blood cholesterol levels. These people may need medicine, in addition to making dietary changes, to bring their cholesterol down to a safe level.

Cholesterol-lowering drugs include:

• Statins
• Niacin
• Bile-acid resins
• Fibric acid derivatives
• Cholesterol absorption inhibitors

Cholesterol-lowering medicine is most effective when combined with a low-fat, high-fiber diet.

How Do Statins Work?

Statins block the production of cholesterol in the liver itself. They lower LDL, the "bad" cholesterol, and triglycerides, and have a mild effect in raising HDL, the "good" cholesterol. These drugs are the first line of treatment for most people with high cholesterol. Side effects can include intestinal problems, liver damage, and in a few people, muscle tenderness.

Examples of statins include:

• Crestor
• Lipitor
• Lescol
• Mevacor
• Pravachol
• Zocor

How Does Nicotinic Acid Work?

Nicotinic acid is a B-complex vitamin. It's found in food, but is also available at high doses by prescription. It lowers LDL cholesterol and raises HDL cholesterol. The main side effects are flushing, itching, tingling and headache. Examples of nicotinic acid medication include:

• Nicolar and Niaspan

How Do Bile Acid Resins Work?

These drugs work inside the intestine, where they bind to bile from the liver and prevent it from being reabsorbed into the circulatory system. Bile is made largely from cholesterol, so these drugs work by depleting the body's supply of cholesterol. The most common side effects are constipation, gas and upset stomach. Examples of bile acid resins include:

• Questran and Questran Light
• Colestid
• WelChol

How Do Fibrates Work?

Fibrates reduce the production of triglycerides and can increase HDL cholesterol. Examples of fibrates include:

• Atromid
• Tricor
• Lopid

Ezetimibe lowers bad LDL cholesterol. Its a new class of cholesterol lowering drug that works to stop cholesterol absorption in the intestine.

What Are the Side Effects of Cholesterol-Lowering Drugs?

The side effects of cholesterol-lowering drugs may include:

• Muscle aches*
• Abnormal liver function
• Allergic reaction (skin rashes)
• Heartburn
• Dizziness
• Abdominal pain
• Constipation
• Decreased sexual desire
• Flushing with nicotinic acid

*If you have muscle aches, call your doctor immediately. This could be a sign of a life-threatening condition.

Are There Foods or Other Drugs I Should Avoid While Taking Cholesterol-Lowering Medicine?

Yes. You should avoid taking other cholesterol-lowering drugs and anticoagulants. Also, you should not drink grapefruit juice and limit fresh grapefruit consumption while taking cholesterol-lowering drugs, as it can interfere with the liver's ability to metabolize these medications.

Reviewed by the doctors and dietitians in the Department of Preventive Cardiology and Rehabilitation at The Cleveland Clinic Heart Center.